The full report is titled “Behavioral Counseling to Promote a Healthful Diet and Physical Activity for Cardio-vascular Disease Prevention in Adults With Cardiovascular Risk Factors: U.S. Preventive Services Task Force Recommendation Statement.” It is in the 21 October 2014 issue of Annals of Internal Medicine (volume 161, pages 587-593). The author is M.L. LeFevre, on behalf of the U.S. Preventive Services Task Force.

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Who developed these guidelines?

The U.S. Preventive Services Task Force (USPSTF) is a group of health experts that reviews published research and makes recommendations about preventive health care.

What is the problem and what is known about it so far?

Cardiovascular disease (CVD), which often takes the form of a heart attack or stroke, is a leading cause of death in the United States. Adults who eat a healthy diet and exercise regularly can be at lower risk for CVD than those who do not. National dietary guidelines recommend that adults consume more vegetables, fruits, whole grains, fat-free and low-fat dairy products, and seafood and less salt, saturated and trans fats, cholesterol, added sugar, and refined grains. Physical activity guidelines advise people to exercise at a moderate level (for example, walking) for at least 30 minutes at least 5 days per week or at a vigorous level (for example, running) for at least 20 minutes at least 3 days per week. Unfortunately, most Americans do not follow these guidelines.

In 2012, the USPSTF considered the evidence showing that counseling programs improve these behaviors and health outcomes in adults without existing CVD or such risk factors as diabetes, high blood pressure, or unhealthy cholesterol levels. At that time, it recommended that physicians and nurses provide counseling to certain patients on the basis of other considerations but not include it in routine primary care for all adults. In the current recommendation, the USPSTF addresses the benefits and risks of primary care–based counseling to promote a healthy diet and physical activity in adults who are above their healthy weight and have known risk factors for CVD, such as borderline diabetes, high blood pressure, unhealthy cholesterol levels, or a previous CVD event.

How did the USPSTF develop these recommendations?

The USPSTF reviewed published literature on whether counseling interventions for healthy eating and physical activity are effective at changing patient behavior, reducing cardiovascular risk factors, decreasing new diagnoses of diabetes, and decreasing CVD events or deaths. It focused on studies of counseling in people with known high blood pressure, prediabetes, high cholesterol levels, or a mixture of CVD risk factors.

What did the authors find?

The USPSTF found evidence that intensive behavioral counseling programs have a moderate benefit in decreasing CVD risk factors in adults who are above their healthy weight and at increased risk for CVD. Reductions in blood sugar levels after such programs seem to be large enough to decrease new diagnoses of diabetes. The USPSTF did not find good direct evidence that such counseling programs decrease CVD events or deaths.

What does the USPSTF recommend that patients and doctors do?

The USPSTF recommends offering or referring adults who are above their healthy weight and have additional CVD risk factors to intensive behavioral counseling programs to promote healthy eating and physical activity for CVD prevention.

What are the cautions related to these recommendations?

The USPSTF found few risks for patients who improved their diet or started exercising more. Some patients might have sore muscles or joints or injure themselves while exercising. The research is not clear on how long the benefits of eating better and exercising more last after counseling ends.

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